It is important to demand ratios in the Québec healthcare network to ensure safe care for the population. The FIQ was the first labour organization in Québec to make gains on the ratios, which resulted in projects in 16 healthcare institutions. The results speak for themselves and it now appears beyond any doubt that those successes should result in a gradual rollout of safe ratios in Québec. A clear political commitment and targets living up to this are therefore essential. However, this should not be seen as a union-only demand. It is, above all, a vital social project, which the patients and healthcare professionals’ safety depends on.
What do safe ratios mean?
We talk about safe ratios to define the presence of a minimum care team at all times for a group of patients with similar health problems based on the required care. Therefore, a safe ratio established for a CHSLD will probably be different to that for maternity or intensive care, for example. This guarantee of minimum care can then be adjusted upwards, based on patients’ needs in specific circumstances
(e.g.: outbreak of infections).
The care team is composed of healthcare professionals (nurses, licensed practical nurses, respiratory therapists and clinical perfusionists), among others, giving direct patient care based on the needs and according to their expertise. All the members of the care team are essential for care safety.
What are the benefits from ratios?
For the healthcare network
- Better healthcare network efficiency
- Improved care quality and safety
- Staff attraction and retention
- Better use of resources
- Lower costs
- Workforce planning
- Lower absenteeism rate
- Enough staff
- Fewer undesirable events (falls, risks of infections, medication errors, etc.)
and associated additional care
- Shorter lengths of stay
- Fewer work accidents
For the care teams
- Delivery of safe and humane care
- Staff stay in the network
- Healthy work environment and attractive positions
- Less job insecurity
- Improved job satisfaction
- Professional life/personal life balance
- Enhanced professional practice and work value
- Adequate teams to meet patients’ needs
- Stabilization of care teams
- Reduced workload and professional burnout
- Less mandatory overtime
- Fewer work accidents
- Lower risk of professional errors
- Better knowledge of and patient follow-up
- More extensive assessments and better documentation
For the population
- Safe and humane care
- Prevention of complications
- Respect of dignity
- Less omitted care because of lack of time
- Fewer adverse events (falls, risk of infections, medication errors, etc.)
- Fewer complications and risks of death
- Adequate pain management
- Better monitoring of the health condition
Explanations of Judith Shindul-Rothschild, Assistant Professor, Faculty of Nursing Sciences at Boston College (in English with French subtitles
Ratios are a solution tested elsewhere in the world with convincing results. This solution is backed by more than fifteen years of scientific literature. Both the scientific literature and international experiences demonstrate that ratios are the key element giving impetus to reverse the workforce shortage. Ratios will improve the quality and safety of care for the patients, attract and retain personnel, and ensure improved efficiency of the healthcare system.
Ratios elsewhere in the world
Safe ratios are already a reality in California, the Australian states of Victoria and Queensland and the country of Wales. In California, ratios have existed for more than 15 years and the following effects have already been documented:
- Improved quality of care
- More time at the patients’ bedsides
- Lower mortality rate
- Fewer readmissions in the 30 days after discharge
- Shorter waiting times in emergencies
- Increase in the number of nurses
- Fewer vacant positions
- Less staff turnover
- More registrations in nursing studies programs
- Increase in the number of graduates
- Fewer work accidents for nurses and licensed practical nurses
Overview of CHSLD ratios in Victoria, Australia (in English with French subtitles)
Ratios in Québec
Why do we need safe ratios in health care in Québec?
In Québec, there are already ratios promoting safety and quality in schools and daycare centres. Such a fixed standard should also exist in healthcare institutions, where the lives of patients are at stake. Ratios are a simple and lasting solution for promoting safe care in Québec and restoring a humane healthcare network in which the population has confidence. They are a good investment for the healthcare network. It would be a win-win situation for everyone!
Both citizens and staff need to be confident that a safe standard will be implemented and this standard is safe ratios. For the FIQ, safe ratios should be guaranteed for all institutions in Québec, regardless of the mission, region or type of care given. Right now, overworked care teams have to make heartbreaking choices and prioritize certain care because of the staff shortages, which unfortunately affect patients’ health outcomes
Québec cannot afford to ignore this solution that has improved care elsewhere in the world and ensured staff attraction and retention. Safe ratios are the solution for addressing the shortage and avoiding that the difficult situation we are in right now, which has only been worsened by the pandemic, does not happen again.
What has happened with the ratio projects conducted in Québec in 2018-2019?
Sixteen ratios projects were conducted jointly with the employers in CHSLD-EPC, medicine, surgery, emergency and home support in different regions of Québec. The positive conclusions of the stakeholders involved, including theFIQ, all converge towards the pertinence of ratios, the need to continue and enlarge the implementation to ensure care safety and resolve the workforce problems
The ratios projects reconciled the staff with the profession and fostered attraction and retention. We also saw among the staff:
- More availability to work given the improved working and working life conditions
- A feeling of safety at work
- Less stress and exhaustion
- More collaboration between colleagues
- Fewer short-term absences and salary insurance in some projects, and greater intention to remain on the job
In general, the projects have shown improved practice and significantly freed up the time necessary to give patients the required care:
- Care/treatments given in the prescribed time
- Patient and loved ones’ satisfaction
- Progress notes
- Care planning
- End-of-life patient management
- Prevention of falls
- Better assessment of the physical and mental condition
- Patients and loved ones included in the care
- In some projects, shorter hospital stays and fewer readmissions, and less time to receive care in emergency
These changes can be seen in the positive comments of families, physicians, beneficiary attendants and other professionals (e.g.: social worker, nutritionist).